Hip Joint Disorders

The hip joint is the largest joint in the human body. The degeneration of a joint is called arthrosis and in medical terminology, the degeneration of the hip joint is called coxarthrosis. In the age group of 60-year-olds, 15 to 20 percent of our population are affected by this.

In Germany, approx. 180,000 hip replacement surgeries are therefore currently performed every year. The reasons for degeneration are numerous. In addition to congenital and acquired deformities and consequences of an accident, other causes that trigger joint destruction include rheumatoid arthritis, gout, excess weight, hard physical labor, and too much strain as a result of sports activities.

Coxarthrosis Symptoms

In joint disorders, a principal distinction needs to be made between pain and functional disorders. These occur concurrently with different degrees of severity.

Pain is usually localized in the groin and radiates from there to the upper thigh and the knee. However, there are also cases of hip arthroses in which the pain is localized primarily in the buttocks or only in the knee. What is common to all forms of arthrosis is the so-called start-up pain after periods of rest. In cases of severe, advanced disease, pain increasingly occurs when the joint is subject to stress, and there may also be pain when resting or at night.

Phases with stronger pain and with less pronounced pain alternate at irregular intervals, which can be explained by bouts of inflammatory changes of the joint and associated swelling of the capsule (activated arthrosis).

When the disease progresses, functional impairments occur, i.e., mobility impairments of the joint, in particular. This primarily affects the internal rotation, the extension, and the abduction of the leg in the hip joint. A characteristic hip limp and a more pronounced hollow back are the visible expressions of these muscular contractures. Patients with hip arthrosis frequently also suffer from severe back pain since the stiffening of the hip places a lot of strain on the connection between the lumbar spine and the pelvis.

Mit dem Fortschreiten der Erkrankung kommt es zu Funktionsstörungen, d.h. vor allem zu Bewegungseinschränkungen des Gelenkes. In erster Linie sind hiervon die Innendrehung, die Streckung und das Abspreizen des Beines im Hüftgelenk betroffen. Ein charakteristisches Hüfthinken und ein verstärktes Hohlkreuz sind der sichtbare Ausdruck dieser muskulären Verkürzungen.

Hüftarthrosepatienten leiden häufig auch unter starken Kreuzschmerzen, da die Einsteifung der Hüfte die Verbindung zwischen Lendenwirbelsäule und Becken stark beansprucht.


Preventing Hip Arthrosis 

Since the introduction of hip sonography for newborns, preventive measures have started in our hospital in the first days of life. The thorough clinical and sonographic examination of the hip joints allows us to detect incomplete development of the hip sockets (hip dysplasia, hip luxation) in newborns already and, if necessary, to initiate treatment.

With careful observation, nutritional deficiencies of the femoral head in children 6 to 10 years old (Perthes disease) as well as disorders in the area of the growth plate of the femoral head (slipped capital femoral epiphysis), which are most frequent in children aged 12 to 15, can be detected in such a timely manner that damage to the hip joint with lifelong consequences does not necessarily have to occur.

Prevention, respectively reduction, of excess weight is particularly important in terms of preventing arthrosis of the joints in the lower extremities.

Sports activities that do not involve high-impact excess strain and stress, on soft, cushioned floors, with appropriately shock-absorbent shoes should be preferred and serve as preventive measures. Suitable types of sports include swimming, bicycling, light jogging, gymnastics, and cross-country skiing.

Eating healthy foods rich in minerals and low in fat and avoiding too many stimulants also contributes to preserving healthy joints. 

Diagnosis

In uncomplicated cases, information about the typical symptoms, a physical exam with determination of the typical mobility impairments, and an X-ray exam providing evidence of characteristic changes of the hip are enough to make a reliable diagnosis of coxarthrosis.

Additional exams such as a CT (computer tomography), an MRT (magnetic resonance tomography), a bone scintigram, as well as lab parameters are, however, necessary in certain constellations to exclude other causes of hip disorders, respectively to confirm the diagnosis of hip arthrosis.


Conservative Hip Arthrosis Therapy

As a matter of principle, the treatment of hip arthrosis is initially conservative. On the one hand, it aims at relieving the pain and, on the other hand, at improving the impaired functionality.

For relieving the pain, anti-inflammatory medication such as Diclofenac, Ibuprofen, or other so-called anti-phlogistics are suitable. In addition, in the acute phases, the patient is advised to apply cold compresses and to take pressure off the joint by using crutches. Preserving as much mobility of the joint as possible is ensured through physiotherapy and exercise baths. Furthermore, special emphasis should be placed on strengthening as well as stretching the muscles that stabilize the joint.

Coordination training and co-treatment of neighboring joints and muscle groups ensure that the period without symptoms lasts as long as possible and that the joint functions in a satisfactory manner despite the presence of joint arthrosis. After the patient has learned the basic techniques and exercises, this form of treatment can also be performed quite well at home.

Other conservative treatment alternatives are aimed at improving the metabolism of the cartilage. In the early phase of arthrosis, injections with various drugs containing hyaluronic acid may indeed lead to a reduction of the speed with which joint degeneration progresses. However, any injection into a joint entails the risk of an infection. Joint injections should therefore only be performed under special conditions of sterility and normally only by specialists. And it is recommended checking the correct placement of the tip of the syringe with the help of an X-ray machine or via ultrasound. In our hospital, we use, among others, the drug Synvisc® manufactured by Genzyme, since its effectiveness has been confirmed by high-quality studies. Injections into the hip joint are generally monitored by radioscopy.

A stimulating effect on the cartilage metabolism is also attributed to Pulsating Signal Therapy (PST). Weak electromagnetic fields transmit biophysical signals to the damaged area and stimulate the damaged tissue to regenerate itself.

Operative Treatment of Hip Arthrosis

When the symptoms from the hip arthrosis can no longer be relieved through conservative measures and when the patient’s quality of life suffers significantly, the time has come to discuss joint replacement surgery (arthroplasty), i.e., an artificial hip joint.

 

 

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